EPIDURAL SPINAL-CORD COMPRESSION AS AN INITIAL SYMPTOM IN CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA - RAPID DECOMPRESSION BY LOCAL IRRADIATIONAND SYSTEMIC CHEMOTHERAPY

We treated an 11-year-old girl with spinal cord compression near an ep idural tumor. Bane marrow examination confirmed the diagnosis of acute lymphoblastic leukemia (ALL). To reduce the compression we treated he r immediately with high-dose dexamethasone and vincristine administere d intravenously along with local irradiation. Three days later, radiat ion was discontinued because magnetic resonance imaging showed that th e spinal cord compression was reduced. Complete remission has continue d without evidence of neurologic sequelae for more than 3 years since diagnosis. Rapid reduction of the blasts resulted in tumor lysis syndr ome, which was treated with conventional management and additional diu resis without hemodialysis. Epidural spinal cord compression in childh ood ALL can be treated effectively with systemic chemotherapy and loca l radiotherapy without laminectomy.